FMGE 2024 - Psychiatry PYQs Practice Questions

Q: What is the medical term for a person who fears seeing tall buildings and looking down from heights?

Acrophobia. ***Acrophobia***- It is the specific phobia defined as the extreme or irrational **fear of heights** or being in high places (like a tall building or cliff). - Symptoms include anxiety, panic attacks, dizziness, and refusal to be in high places or even look down from them. *Agoraphobia* - This refers to an anxiety disorder characterized by the fear of being in places or situations from which escape might be difficult or help unavailable, such as **open spaces**, public transportation, or crowds. - It is frequently associated with a fear of having a **panic attack** and being unable to escape. *Claustrophobia* - This is the irrational fear of **confined spaces** or enclosed areas, such as elevators, small rooms, or tunnels. - It is not related to vertical distance or looking down from a height. *Nomophobia* - This is a colloquial term for the fear of being without a **mobile phone** or being unable to use it (e.g., due to loss of signal or battery). - This type of phobia involves anxiety related to technological dependence, not environmental features like height. [Practice more Psychiatry PYQs on OnCourse]

Q: A mother presented her daughter with complaints that she has started behaving weirdly about her food habits for the last few months. She eats a lot of burgers in one go, and then she vomits it out. Her BMI is 27. What is the most probable diagnosis?

Bulimia nervosa. ***Bulimia nervosa***- Involves recurrent episodes of **binge eating** followed by inappropriate **compensatory behaviors** (like self-induced **vomiting**, excessive exercise, or laxative use).- Unlike **anorexia nervosa**, patients with bulimia nervosa typically maintain a body weight that is normal or overweight (BMI $\geq$ 18.5), which aligns with the given BMI of 27.*Anorexia nervosa*- The primary criterion requires the patient to have a weight that is significantly low for their age and height (e.g., BMI $\leq$ 17.5 in adults).- This diagnosis is excluded because the patient's BMI is 27, placing her in the **overweight** category.*Binge eating disorder*- Characterized by recurrent episodes of **binge eating** without inappropriate use of **compensatory behaviors** (purging).- This patient engages in **vomiting** after eating, which is a compensatory behavior that rules out a diagnosis of simple binge eating disorder.*OCD*- Involves the presence of **obsessions** (recurrent, intrusive thoughts) and/or **compulsions** (repetitive behaviors) that cause significant distress.- While eating disorders can feature obsessive elements, the core presentation of binging followed by compensatory purging is specific to **bulimia nervosa**, not Obsessive-Compulsive Disorder. [Practice more Psychiatry PYQs on OnCourse]

Q: A patient was given an antipsychotic drug, haloperidol, and the patient developed acute dystonia. Which is the next best step?

Give Benztropine. ***Give Benztropine***- **Acute dystonia** is a severe extrapyramidal symptom (EPS) requiring rapid intervention, often treated intramuscularly or intravenously.- **Benztropine** (an anticholinergic agent) is the drug of choice for the immediate management of acute dystonia, working to restore the balance between dopamine and acetylcholine.*Change to clozapine*- While **clozapine** has a significantly lower risk of causing acute dystonia, it is not the initial treatment for an acute episode due to its slow titration requirements and side-effect profile.- Switching to clozapine is a long-term strategy for patients intolerant to other antipsychotics, not an acute rescue medication.*Give Fluphenazine*- **Fluphenazine** is a high-potency first-generation antipsychotic, similar to haloperidol, which also carries a high risk of EPS.- Administering another high-potency antipsychotic would perpetuate the excessive **dopaminergic blockade** responsible for the acute dystonia.*Increase dose of haloperidol*- **Acute dystonia** is a direct dose-related side effect of D2 receptor blockade by haloperidol in the nigrostriatal pathway.- Increasing the dose of **haloperidol** would worsen the underlying neurochemical imbalance, thereby intensifying the dystonic symptoms. [Practice more Psychiatry PYQs on OnCourse]

Q: What is the diagnosis for a patient who believes their bodily sensations or movements are controlled or influenced by an external agency?

D. Somatic passivity. ***Somatic passivity***- This symptom describes the delusional belief that one's **bodily sensations**, movements, or actions (e.g., movements of the limbs, feelings in the body) are being controlled or imposed upon by an **external agency** or force.- It is considered one of **Schneider's First-Rank Symptoms** (FRS) of **schizophrenia**, highlighting profound disturbances in self-boundaries and agency.*Delusion of nihilism*- This delusion, often seen in severe depression or psychosis (e.g., **Cotard's syndrome**), is the belief that one is dead, does not exist, or that parts of the body or the world do not exist.- It does not involve the feeling of **external control** or influence over existing bodily movements or sensations.*Delusion of reference*- This is the belief that otherwise innocuous or neutral events, objects, or people's actions in the environment have a particular and unusual meaning specifically **referring to oneself**.- It relates to interpreting the environment (e.g., hearing a radio broadcast talking *about* them), not the feeling of bodily movements being **controlled by external forces**.*Othello syndrome*- Also known as **morbid jealousy** or **delusional jealousy**, this is a specific type of delusional disorder characterized by the fixed, unfounded belief that one's partner is being **unfaithful**.- It is focused strictly on relationships and fidelity and has no association with beliefs of external control over **somatic functions**. [Practice more Psychiatry PYQs on OnCourse]

Question 1

What is the medical term for a person who fears seeing tall buildings and looking down from heights?

Accepted Answer

Acrophobia

Answer

Nomophobia

Answer

Claustrophobia

Answer

Agoraphobia

Question 2

A mother presented her daughter with complaints that she has started behaving weirdly about her food habits for the last few months. She eats a lot of burgers in one go, and then she vomits it out. Her BMI is 27. What is the most probable diagnosis?

Accepted Answer

Bulimia nervosa

Answer

Anorexia nervosa

Answer

OCD

Answer

Binge eating disorder

Question 3

A patient was given an antipsychotic drug, haloperidol, and the patient developed acute dystonia. Which is the next best step?

Accepted Answer

Give Benztropine

Answer

Give Fluphenazine

Answer

Increase dose of haloperidol

Answer

Change to clozapine

Question 4

What is the diagnosis for a patient who believes their bodily sensations or movements are controlled or influenced by an external agency?

Accepted Answer

D. Somatic passivity

Answer

C. Othello syndrome

Answer

A. Delusion of nihilism

Answer

B. Delusion of reference

FMGE 2024 — Psychiatry